Outpatient Neurological Rehabilitation Victoria General Hospital. Pam Loadman BSC.P.T., MSc. Physiotherapist

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1 Outpatient Neurological Rehabilitation Victoria General Hospital Pam Loadman BSC.P.T., MSc. Physiotherapist

2 OPN - overview Who we see: Inclusion criteria Diagnoses Who we are: Clinicians involved What we do: Type of Assessment/ Treatments How its done: Referral process Waitlists

3 OPN - overview Interdisciplinary outpatient neurological rehabilitation team Main floor VGH, behind emergency department 8 4 pm Assessment and treatment or consult only Dr. (or nurse practitioner) referrals for patients residing on Vancouver Island

4 Inclusion Criteria Adults (or teen out of high school) Acquired central nervous system impairment i.e. no peripheral nerve impairments or neuropathies Significant change in physical and/or functional status new injury/condition OR chronic condition with new problems (old stroke, new change in function) Tolerates minutes of activity/therapy plus trip to and from VGH Transportation

5 Fast track stroke criteria Early high intensity intervention results in improved outcomes Stroke within 3 months of referral Mainly motor impairment Referrals from Rapid Stroke Assessment Unit (VGH) Acute Care Inpatient Rehabilitation Unit Dr office

6 OPN who we see FTS Stroke ABI Traumatic injury Subdural bleeds Tumors SCI MS e.g. Parkinson's cerebellar ataxia

7 OPN Interdisciplinary Team Occupational therapy Neuropsychology Speech Language Pathology Physiotherapy Patient Recreation Therapy Neuro-Psychiatry Physiatry Social Work

8 OPN Assessments and Treatment Referral Simple Single discipline Coordinated Requires ID team approach

9 OPN - Treatment Goal oriented Time limited Maximum 10 weeks (with some flexibility) Goals reviewed at 5 weeks

10 OPN - Treatment PT OT SLP RT SW Psych Individual therapy Group therapy Attention training Listening Education Wellness Moving On Hand Class

11 OPN when to refer cognitive deficit attention, organization, memory, problem solving, planning, language and writing (receptive and expressive) OT, SLP, Neuropsychology vision, visual perception and vestibular deficits OT, PT physical deficit spasticity, balance, coordination, gait impairment, falling PT, OT return to work OT, PT, SLP, neuropsychology (testing), SW community integration OT,PT, SLP, RT,SW Speech and swallowing deficit SLP

12 Referral Process Dr. referral Do not need to go through Rehab Medicine Weekly Intake (team) Fast track stroke Assessment (within 2 weeks) Other Functional Interview (Within 2 weeks) Simple or Team Assessment(s) Waitlist 1-3 months HCC Rehab Med Psych **Simple physio often less

13 Referral Sources SRAU, MS clinic VGH Rehab Dr. office VGH acute RJH

14 PHONE: GINA FAX:

15 OUTPATIENT NEUROLOGICAL REHABILITATION PROGRAM Assessment Summary Dear Dr. The above patient was assessed by the following disciplines on dates indicated. findings, intervention will be offered in the following areas: Occupational Therapy Date: Based on assessment visual perceptual function cognitive skills fine motor function ADLs Occupational Therapist: Physiotherapy attentional skills and memory fatigue/energy management management of ADLs or instrumental Date: vestibular function conditioning, activity tolerance fine motor coordination gross motorfunction/mobility balance fall prevention pain Physiotherapist: Speech Therapy ate: expressive language skills receptive language skills voice motor speech/dysarthria swallowing

16 Acute Concussion follow-up Early intervention (education and reassurance) helps prevent the development of post-concussive syndrome Referrals from Emergency department only Phone interview and screening questionnaire within a week of presentation to Emergency by psychology assistant Phone follow up by neuropsychologist for education, reassurance and any recommendations or referrals to Physiatrist OPN Counselling

17 Other IH Options: Home and Community Care OT/PT/SW/Nursing In-home assessments for safety and acute problems Short-term treatment for those unable to access OP services RRAD Regional Resources for Adults with Disability For those pts for whom in home rehab is most appropriate (OT/PT/RT) Energy deficits Cognitive impairment -inability to integrate information from clinic to home Treatment requires use of home or community environment (specific equipment use, stairs, community access) Phone HCC Central Intake: HCC Referral form: A42F-148CFB9565B0/0/gen_65a_fillable.pdf

18 HCC Brain Injury Program (BIP) **funding and support services NOT rehabilitation** Assist in obtaining transitional or permanent housing Supported apartments, group homes, family care homes Provide and subsidize support workers to support community access and assist with instrumental activities of daily living (shopping, leisure and recreation) BIP:

19 QUESTIONS?

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